Mixed Deck — All NNP Topics Flashcards

During a difficult resuscitation, the team leader notices escalating tension. Which communication technique best maintains team performance?

Answer: Closed-loop communication with role clarity and directed task assignment

Closed-loop communication with clear role assignments prevents errors of omission and maintains situational awareness during high-stress neonatal resuscitation.

The following action should be taken if a patient's membranes burst and meconium-tinted amniotic fluid is discovered.

Answer: Increased fetal monitoring

Meconium-tinted amniotic fluid can indicate fetal stress or hypoxia, which increases the risk of meconium aspiration syndrome. The primary action is to increase fetal monitoring to closely assess the fetal heart rate pattern for signs of distress. This allows for timely intervention if the fetal condition deteriorates, ensuring the well-being of the fetus.

A term infant is diagnosed with persistent pulmonary hypertension (PPHN). After failing to respond to 100% oxygen, which pharmacologic agent is the first-line treatment?

Answer: Inhaled nitric oxide (iNO)

Inhaled nitric oxide is the first-line selective pulmonary vasodilator approved for PPHN in term and near-term infants.

Neonatal early-onset sepsis (72 hours) typically manifests as

Answer: Pneumonia

Early-onset neonatal sepsis, typically occurring within the first 72 hours of life, is most commonly acquired vertically from the mother during birth. The most frequent clinical manifestation of early-onset sepsis is pneumonia, often presenting with respiratory distress. While bacteremia is present and meningitis can occur, pneumonia is considered the typical and most common presentation.

Which of the following is the most appropriate intervention for a neonate with a confirmed choanal atresia causing respiratory distress?

Answer: Place an oral airway and prepare for surgical repair

Choanal atresia causes respiratory distress because neonates are obligate nasal breathers; an oral airway bypasses the obstruction until surgical repair.

Which factor is the strongest predictor of IVH in premature neonates?

Answer: Lower gestational age and birth weight

IVH risk is inversely related to gestational age and birth weight; extremely premature infants have the most fragile germinal matrix vasculature.

Vitamin K is routinely administered to neonates at birth to prevent:

Answer: Hemorrhagic disease of the newborn (HDN)

Neonates have low vitamin K stores and lack gut flora to produce it, predisposing them to bleeding; prophylactic vitamin K prevents HDN.

Which antifungal is most commonly used for invasive candidiasis in premature neonates?

Answer: Fluconazole IV

Fluconazole IV is the first-line treatment for invasive neonatal candidiasis due to its established safety profile and good CNS penetration.

A neonate has an arterial blood gas showing pH 7.15, PaCO2 40, HCO3 14. What drug treatment addresses the underlying metabolic cause?

Answer: Sodium bicarbonate (cautiously for severe metabolic acidosis)

Sodium bicarbonate may be used cautiously for severe, documented metabolic acidosis after ensuring adequate ventilation, as CO2 is normal in this case.

A neonate with congenital hypothyroidism requires levothyroxine therapy. What is the main reason for urgent treatment?

Answer: Prevent irreversible neurodevelopmental impairment

Early thyroid hormone replacement is critical because thyroid hormone is essential for brain maturation; untreated hypothyroidism causes permanent intellectual disability.

A term neonate develops jaundice at 18 hours of age. Which of the following is the MOST likely cause?

Answer: ABO incompatibility hemolytic disease

Jaundice appearing within the first 24 hours of life is pathologic and most commonly caused by hemolytic disease such as ABO incompatibility.

What is the recommended initial FiO2 for resuscitation of a term neonate at birth in the US?

Answer: 21%

Current NRP guidelines recommend starting resuscitation of term neonates with room air (21% FiO2) and titrating based on pulse oximetry.

Which four-extremity blood pressure finding is most consistent with coarctation of the aorta?

Answer: Higher blood pressure in upper extremities than lower extremities by >10 mmHg

Coarctation of the aorta causes upper extremity hypertension and reduced perfusion pressure in the lower extremities, creating a measurable gradient.

Dopamine at low doses (2-5 mcg/kg/min) primarily acts on which receptors in neonates?

Answer: Dopaminergic receptors increasing renal and mesenteric perfusion

Low-dose dopamine primarily stimulates dopaminergic receptors, promoting renal and mesenteric vasodilation, though this effect is less reliable in neonates.

Nonnutritive sucking (NNS) during tube feeding in premature infants is beneficial because it:

Answer: Promotes GI maturation, weight gain, and oral feeding transition

NNS stimulates GI hormones, promotes suck-swallow coordination, and is associated with faster transition to full oral feeding and improved weight gain.

A neonate has an abnormal head ultrasound showing bilateral periventricular echogenicity. What follow-up imaging is recommended?

Answer: Serial head ultrasound and MRI at term-corrected age

Serial head ultrasound monitors lesion evolution, and MRI at term-corrected age provides definitive assessment of white matter injury extent and neurodevelopmental prognosis.

Total parenteral nutrition (TPN) in neonates typically starts with which amino acid concentration to promote anabolism?

Answer: 3-4 g/kg/day starting on day 1

Current evidence supports early, aggressive protein provision of 3-4 g/kg/day from day 1 to promote positive nitrogen balance and prevent catabolism in preterm neonates.

A neonate receiving IV lipid infusion develops a triglyceride level of 350 mg/dL. What is the appropriate action?

Answer: Reduce or hold the lipid infusion until levels normalize

Hypertriglyceridemia indicates impaired lipid clearance; reducing or holding the lipid infusion prevents complications such as lipemia retinae and coagulopathy.

Which of the following is the least accurate statement on the sensory capacities of a full-term newborn?

Answer: At term, the healthy newborn does not yet have an ability to fix on and track objects visually

This statement is inaccurate because full-term newborns are indeed capable of fixing their gaze on objects, especially faces, and can track moving objects. While their vision is not fully developed, they possess these basic visual tracking abilities from birth. They typically prefer high-contrast patterns and can focus on objects within an optimal range of about 8-12 inches.

What is the primary mechanism by which phototherapy reduces serum bilirubin levels?

Answer: Converts unconjugated bilirubin to water-soluble photoisomers excreted without conjugation

Phototherapy converts unconjugated bilirubin in the skin to structural and configurational isomers (lumirubin and photobilirubin) that are water-soluble and can be excreted in bile and urine without hepatic conjugation.